(a) Title, Scope of Practice, Delegation.

(1) (A) Advanced Practice Registered Nurse (APRN) is the title given to an individual licensed to practice advanced practice registered nursing within one (1) of the following roles:

(i) nurse practitioner (NP),

(ii) certified registered nurse anesthetist
(CRNA),

(iii) certified nurse-midwife (CNM) or clinical nurse specialist (CNS),

and who practices in a population focus as set forth in this Section and Guam Administrative Rules and Regulations.

(B) An APRN may serve as a primary or acute care provider of record.

(2) Population Focus. The APRN shall focus his or her practice in one (1) or more of the following populations:

(A) family/individual across the lifespan; (B) adult-gerontology;
(C) neonatal; (D) pediatrics;
(E) women’s health/gender-related; or

(F) psychiatric/mental health.

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(3) Scope of Practice. APRN practice shall include, but is not limited to:

(A) conducting an advanced assessment;

(B) ordering and interpreting diagnostic procedures;

(C) establishing primary and differential diagnoses;

(D) prescribing, ordering, administering, dispensing and furnishing therapeutic measures as set forth in Subsection (e) of this Section;

(E) delegating and assigning therapeutic measures to assistive personnel;

(F) consulting with other disciplines and providing referrals to health care agencies, health care providers, and community resources;

(G) wearing identification which clearly identifies the nurse as an APRN when providing direct patient care, unless wearing identification creates a safety or health risk for either the nurse or the patient;

(H) admitting patients to a hospital, skilled nursing facility or nursing home, and ordering discharge to home, consistent with professional standards and commensurate with the APRN’s education, certification, demonstrated competencies, and experience;

(I) authority to receive direct, third-party reimbursement from Medicare, Medicaid, and other health insurance carriers;

(J) other acts that require education and training consistent with professional standards and commensurate with the APRN’s education, certification, demonstrated competencies, and experience; and

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(K) other practice as determined by Guam
Administrative Rules and Regulations.

(4) APRNs are licensed independent practitioners within standards established or recognized by the Board. Each APRN is accountable to patients, the nursing profession, and the Board for:

(A) complying with the requirements of this Section and the quality of advanced nursing care rendered;

(B) recognizing limits of knowledge and experience;

(C) planning for the management of situations
beyond the APRN’s expertise; and

(D) consulting with or referring patients to other health care providers as appropriate.

(5) (A) The APRN may delegate to employees or support staff activities relating to advanced practice registered nursing carried out by custom and usage when the activities are under the control and direct supervision of the APRN.

(B) The APRN is legally liable for properly delegated activities; and the employee or support staff to which the APRN has delegated activities is considered the APRN’s agent when performing such activities.

(b) Licensure.

(1) Initial License. An applicant for initial licensure to practice as an APRN shall:

(A) submit a completed written application and appropriate fees as established by the Board;

(B) hold a current Guam RN license or privilege to practice;

(C) not hold an encumbered license or privilege to practice as an RN, defined as a license or privilege

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having current discipline, conditions, or restrictions in any jurisdiction;

(D) have committed no acts or omissions that are grounds for disciplinary action under the Nurse Practice Act, Title 10 Guam Code Ann., Chapter 12, Article 3, or Guam Administrative Rules and Regulations;

(E) have completed an accredited graduate or post-graduate level APRN program in one (1) of the four (4) roles (NP, CRNA, CNM, CNS), and at least one (1) population focus provided in Subsection (a)(2) of this Section;

(F) be currently certified by a national certifying body recognized by the Board in the APRN role and population foci appropriate to educational preparation;

(G) report any criminal conviction, nolo contendere plea, Alford plea, or other plea arrangement in lieu of conviction; and

(H) provide other evidence as required by Guam
Administrative Rules and Regulations.

(2) Endorsement. The Board may issue a license by endorsement to an APRN licensed under the laws of another jurisdiction if, in the opinion of the Board, the applicant meets the qualifications for licensure in Guam. An applicant for APRN licensure by endorsement shall:

(A) submit an official APRN program transcript and a completed written and notarized application with appropriate fees as established by the Board;

(B) hold a current license or privilege to practice as an RN and APRN in another jurisdiction;

(C) not hold an encumbered license or privilege to practice as an APRN, or its equivalent, defined as a license or privilege having current discipline, conditions or restrictions in any jurisdiction;

(D) have completed an accredited graduate or post-graduate level APRN program in one (1) of the four

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(4) roles (NP, CRNA, CNM, CNS), and at least one (1) population focus provided in Subsection (a)(2) of this Section, or meets the standards for grandfathering as described in Subsection (g) of this Section;

(E) be currently certified by a national certifying body recognized by the Board in the APRN role, and at least one (1) population focus appropriate to educational preparation;

(F) meet continued competency requirements as set forth under Guam Administrative Rules and Regulations;

(G) report any conviction, nolo contendere plea, Alford plea, or other plea arrangement in lieu of conviction;

(H) have committed no acts or omissions that are grounds for disciplinary action under the Nurse Practice Act, Title 10 Guam Code Ann., Chapter 12, Article 3, or Guam Administrative Rules and Regulations; and

(I) provide other evidence as required by Guam
Administrative Rules and Regulations.

(3) Denial. The Board may deny APRN licensure to any applicant whose professional license was revoked or suspended in another jurisdiction if the basis for the license revocation or suspension would have caused a similar result in Guam, or if the applicant is the subject of pending disciplinary action regarding his or her right to practice in another jurisdiction.

(4) Temporary License. A nationally certified APRN who has met the professional nurse temporary license requirements of the Board may be issued a nonrenewable, temporary APRN license by the Board that shall be valid for a period of ninety (90) calendar days from the date of issuance.

(5) Renewal. APRN licenses issued under this Section shall be renewed biennially, or more frequently, as determined and in accordance with a schedule made publicly

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available by the Board. An applicant for APRN license renewal shall:

(A) submit a renewal application with appropriate fees as established by the Board;

(B) maintain national certification in the appropriate APRN role and at least one (1) population focus, authorized by licensure, through an ongoing certification maintenance program of a nationally recognized certifying body recognized by the Board as set forth in this Section and Guam Administrative Rules and Regulations, Title 25, Chapter 6, Article 5; and

(C) meet other requirements set forth in Guam
Administrative Rules and Regulations.

(6) The Board may reactivate or reinstate an APRN license as set forth in Guam Administrative Rules and Regulations.

(c) Titles and Abbreviations.

(1) Only those persons who hold a license or privilege to practice advanced practice registered nursing in Guam shall have the right to use the title “”advanced practice registered nurse,”” “”nurse practitioner,”” “”certified registered nurse anesthetist,”” “”certified nurse-midwife,”” or “”clinical nurse specialist””; or the abbreviations “”APRN,”” “”NP,”” “”CRNA,”” “”CNM,”” and “”CNS,”” respectively.

(2) The abbreviation for the APRN designation of a nurse practitioner, certified registered nurse anesthetist, certified nurse-midwife, and clinical nurse specialist will be “”APRN,”” followed by the appropriate role title, i.e., “”NP,”” “”CRNA,”” “”CNM,”” and “”CNS.””

(3) It shall be unlawful for any person to use the title “”APRN”” or “”APRN”” plus any respective role title, the role title alone, otherwise authorized abbreviations or any other title that would lead a person to believe the individual is an APRN, unless permitted by the Nurse Practice Act, 10 Guam Code Ann., Chapter 12, Article 3.

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(d) Education Programs.

(1) The Board shall, by administrative rules, set standards for the establishment and outcomes of APRN education programs, including clinical learning experiences, and approve such programs that meet the requirements of the Act and Board rules.

(2) The Board shall, by administrative rules, identify the process for determining APRN education program compliance with standards.

(3) The Board shall set requirements for the establishment of a new APRN education program. New programs shall be preapproved by a national APRN accrediting body.

(e) Prescribing, Ordering, Dispensing and Furnishing
Authority.

(1) The Board shall grant, through the APRN license, authority to prescribe, order, dispense and furnish, which includes the authority to:

(A) diagnose, prescribe and institute therapy or referrals of patients to health care agencies, health care providers and community resources;

(B) prescribe, procure, administer, dispense and furnish pharmacological agents, including over the counter, legend and controlled substances; and

(C) plan and initiate a therapeutic regimen that includes ordering and prescribing non-pharmacological interventions, including, but not limited to, durable medical equipment, medical devices, nutrition, blood and blood products, and diagnostic and supportive services, including, but not limited to, home health care, hospice, and physical and occupational therapy.

(2) The APRN shall secure and maintain a Federal Drug Enforcement Agency (DEA) registration number, and comply with all state and federal laws and regulations prior

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to prescribing Scheduled Drugs II-V as outlined in this
Subsection (e).

(f) Discipline. APRN discipline and proceedings shall be the same as stated in §§ 12324 and 12325 of this Article for registered nurses and licensed practical nurses.

(g) Implementation. Any person holding a license to practice nursing as an APRN in Guam that is valid upon enactment of this law shall be deemed to be licensed as an APRN under the provisions of this Section with their current privileges, and shall be eligible for renewal of such license under the conditions and standards prescribed in this Section.

SOURCE: Repealed and reenacted by P.L. 24-206:3 (May 13, 1998). Repealed and reenacted by P.L. 34-078:2 (Feb. 9, 2018).

2018 NOTE: Subsection/subitem designations altered/added pursuant to the authority granted by 1 Guam Code Ann. § 1606.